Transurethral resection of the prostate (TURP) with low dose spinal anesthesia in outpatients: a 5 year review.

INTRODUCTION: Spinal anesthesia for ambulatory transurethral resection of the prostate (TURP) is a well established technique. The following study examines data over a 5 year period at a major Canadian tertiary academic center. The purpose of the study is to review our experience and complications associated with spinal anesthesia using combined low dose local anesthetic + narcotic for ambulatory TURP procedures. METHODS: Medical records were reviewed retrospectively on all ambulatory TURP patients over a 5 year period between January 2000 and September 2005 in our Surgical Day Care Center. All spinal anesthetics were reviewed and based on dosage, classified into low dose bupivacaine (< 10 mg; Group LD-B), conventional dose lidocaine (> 35 mg; Group CD-L) or low dose lidocaine (≤ 35 mg; Group LD-L). Primary end points of interest were duration of spinal block and duration of postanesthesia care unit (PACU) stay. RESULTS: A total of 1064 TURPs were performed during the study period. Within this cohort of 334 spinal anesthetics administered, 27 were excluded for lack of data leaving 307 cases for analysis. Patient demographics were normally distributed. Mean doses of spinal local anesthetics administered were: Group LD-B 7.3 ± 2 mg, Group CD-L 52.2 ± 13 mg and Group LD-L 29 ± 5.2 mg. Intrathecal fentanyl was often added to the local anesthetic as an adjunct. Block regression times (Group LD-B 273 ± 98 mins, Group CD-L 174 ± 47 mins and Group LD-L 159 ± 45 mins) and discharge times (Group LD-B 309 ± 94 mins, Group CD-L 230 ± 71 mins and Group LD-L 227 ± 75 mins) were significantly lesser in both lidocaine groups compared to Group LD-B (p <0.05). The frequency of prolonged spinal blocks (> 3 hr) in Groups LD-L, CD-L and LD-B was 23%, 43% and 83% respectively (p < 0.05). CONCLUSION: Low dose spinal anesthesia with bupivacaine and lidocaine were well tolerated for short duration TURP. Low dose bupivacaine and conventional dose lidocaine were associated with significantly longer block duration, longer PACU stay and higher frequency of prolonged blocks compared with low dose lidocaine for spinal anesthesia.

A pulsatile pressure waveform is a sensitive marker for confirming the location of the thoracic epidural space.

OBJECTIVES: The purpose of this study was to assess the validity of using a pulsatile, pressure waveform transduced from the epidural space through an epidural needle or catheter to confirm correct placement for maximal analgesia and to compare 3 different types of catheters' ability to transduce a waveform. DESIGN: A single-center, prospective, randomized trial. SETTING: A tertiary-referral hospital. PARTICIPANTS: Eighty-one patients undergoing posterolateral thoracotomy who required a thoracic epidural catheter for postoperative pain management. INTERVENTIONS: Each epidural needle and each epidural catheter was transduced to determine if there was a pulsatile waveform exhibited. MEASUREMENTS AND MAIN RESULTS: Sensitivity of the pulsatile waveform transduced through an epidural needle to identify correct placement of the epidural needle and the sensitivity of each catheter type to identify placement were compared. In 79 of 81 cases (97.5%), the waveform transduced directly through the epidural needle had a pulsatile characteristic as determined by blinded observers. In a total of 53 of 81 epidural catheters (65.4%), the transduced waveform displayed pulsations. Twenty-four of 27 catheters in group S-P/Sims Portex (Smiths Medical MD, Inc, St Paul, MN) (88.9%) transduced a pulsatile tracing from the epidural space, a significantly greater percentage than in the other 2 groups (p = 0.02). CONCLUSIONS: The technique of transducing the pressure waveform from the epidural needle inserted in the epidural space is a sensitive and reliable alternative to other techniques for confirmation of correct epidural catheter placement. The technique is simple, sensitive, and inexpensive and uses equipment available in any operating room.

Sedation and analgesia in the interventional radiology department.

Administration of sedation and analgesia in the interventional radiology suite is often necessary during painful diagnostic and therapeutic procedures. Although sedative and analgesic agents are generally safe, catastrophic complications related to their use can occur, often as a result of incorrect drug administration or inadequate patient monitoring. The incidence of adverse outcomes related to provision of sedation and analgesia can be reduced with improved understanding of the pharmacology of these medications, by providing adequate monitoring to sedated patients, by recognizing patients who are at increased risk of experiencing an adverse drug reaction, and by early and appropriate management of complications.

Herbal medicine use is frequent in ambulatory surgery patients in Vancouver Canada.

PURPOSE: To determine the incidence and nature of herbal medicine use among patients in a busy Canadian surgical day care unit. METHODS: We undertook a prospective survey of 575 patients attending our surgical day care unit. The questionnaire inquired as to basic demographics, herbal medicine use, the name and number of herbal medicines used, reason, whether it was self prescribed or not, and if the patient's family physician was aware of the use. In the second part of the study, 44 anesthesiologists were asked to answer a questionnaire of 27 yes/no questions to determine their knowledge of herbal medicines. RESULTS: Four hundred eighty-five of 575 patients completed the questionnaire (84%). Thirty-four percent of patients surveyed in our unit responded affirmatively to herbal medicine use. Of these, 39% took them on a daily basis. Forty-five different identifiable herbs were being taken in total, with echinacea being the most common. Less than half of the patients told their family physicians that they were using herbal medicines and only one-third of patients were taking them on the advice of their physician. In the assessment of anesthesiologists' knowledge of herbal medicine, only 32% of the questions were answered correctly. CONCLUSION: The incidence of herbal medicine ingestion by patients coming to our unit was higher than previously reported. A large variety of preparations were being taken, many without the knowledge of the patient's family physician. The basic knowledge of anesthesiologists with respect to herbal medicine is limited.

Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: a pharmacoeconomic comparison.

UNLABELLED: We compared the cost and effectiveness of selective spinal anesthesia (SSA) with a desflurane-based general anesthetic (DES) for outpatient gynecological laparoscopy. A prospective analysis was undertaken of 10 patients randomized to receive SSA and compared with 10 patients randomized to receive DES. The groups were well matched in their demographic characteristics. The mean cost (in 2000 Canadian dollar values) of anesthesia supplies, drugs, and nursing for the SSA group of $62.31 was less than that for the DES group of $92.31 (P < 0.01). Recovery costs of both groups were similar. Time to administer anesthesia and time spent in the postanesthetic care unit were also similar. Postoperative analgesia was required by 50% of the DES group but in no patient receiving SSA (P < 0.01). SSA is a cost-effective alternative to DES in these patients. IMPLICATIONS: Small-dose spinal anesthesia is an effective alternative to a desflurane general anesthetic in terms of cost and recovery profiles in ambulatory gynecological laparoscopy.

Small-dose selective spinal anesthesia for short-duration outpatient laparoscopy: recovery characteristics compared with desflurane anesthesia.

UNLABELLED: We conducted a randomized controlled trial to compare the recovery characteristics of selective spinal anesthesia (SSA) and desflurane anesthesia (DES) in outpatient gynecological laparoscopy. Twenty ASA physical status I patients undergoing gynecological laparoscopy were randomized to receive either SSA with lidocaine 10 mg + sufentanil 10 microg or general anesthesia with DES and N(2)O. Intraoperative conditions, recovery times, postanesthesia recovery scores, and postoperative outcomes were recorded. Intraoperative conditions were comparable in both groups. All patients in the SSA group were awake and oriented at the end of surgery, whereas patients in the DES group required 7 +/- 2 min for extubation and orientation. SSA patients had a significantly shorter time to straight leg raising (3 +/- 1 min versus 9 +/- 4 min; P < 0.0001) and to ambulation (3 +/- 0.9 min versus 59 +/- 16 min; P < 0.0001) compared with the DES group. SSA patients had significantly less postoperative pain than DES patients (P < 0.05). We concluded that SSA was an effective alternative to DES for outpatient gynecological laparoscopy. IMPLICATIONS: This study compared the use of a desflurane general anesthetic to a small-dose spinal anesthetic in ambulatory gynecological laparoscopy. Using the spinal technique, patients can walk from the operating room table to a stretcher on completion of surgery. Their recovery time was similar to that of the desflurane group.